Perineum: I tested three objects for you to take care of it

Try to avoid episiotomy with Epi-No

Epi-no Delphine Plus is a medical device invented by a German gynecologist, Dr Horkel, after he observed African women. Some would prepare for the birth by using larger and larger gourds to stretch and strengthen the pelvic floor muscles, and thus prevent a torn perineum.

The gynecologist then designed a small balloon named Epi-no, which, as the name suggests, aims to prevent an episiotomy or tearing of the perineum.

The device looks like a small blue pear, a medical silicone balloon, which will be inflated once inserted into the vagina using a manual pump. It also has a pressure indicator. In parallel with massages, the balloon would work on the elasticity and flexibility of the perineal area, in order to keep it intact during vaginal delivery.

It should be noted, however, that the French National College of Gynecologists and Obstetricians (CNGOF) considered in a document published in December 2018 that the use of Epi-No “does not provide any benefit in terms of obstetric perineal protection“. The CNGOF prefers perineal massage during pregnancy, who “Should be encouraged in women wishing to practice it“.

Epi-No: how does it work?

At first, the device is inserted into the vagina without inflating it, with a little water-based lubricant if necessary. We will thus be able to locate the muscles of the pelvic floor, and gradually improve their flexibility and elasticity. And learn to relax when ripping! Because the goal will be to gradually inflate the balloon once inserted into the vagina, and to take it out very slowly. Over the sessions, we will inflate the ball more and more, until we feel a little uncomfortable. The final objective: to be able to extract the balloon without sequelae when it is between 9 and 10 cm in diameter, or roughly the diameter of a newborn’s head. But if we are at 8 cm near the end, it is already very good.

It is advisable to train every day from the 37th week of pregnancy (39 WA), from 1 to 2 sessions maximum per day. 15 to 30 minutes per session are sufficient.

Note that the device can also be used after childbirth, to start rehabilitation of the perineum. But this function convinced us less, because it is much less effective than perineal rehabilitation supervised by a midwife or a specialized physiotherapist.

Advantage:

• Several scientific studies (available on the website epino.fr) report a reduced risk of perineum tearing and episiotomy. These are however controversial because they are carried out on relatively few women.
• Psychologically, it is very encouraging to know that one manages to extract a balloon of 8 cm in diameter from the vagina without any scratch! We arrive more serene at childbirth.
• We quickly see his progress: going from 5 cm in diameter to 7-8 cm in a few days is rewarding.

Disadvantages:

• Medical advice should be sought to avoid any risk of premature delivery (especially in the case of placenta previa).
• The price ! The device costs 116,40 euros, including 25,92 € reimbursed by Social Security on prescription. Some mutuals lighten the bill a bit, but not all.
• You have to commit to one to two sessions per day to progress. Possible when you don’t have a child yet, but much less when you already have one or more children to manage on a daily basis.

My impressions :

We often compare, and rightly so, childbirth at a marathon, both in terms of intensity and training. As you do not participate in a marathon without having prepared well beforehand, you do not give birth without a minimum of preparation. Epi-no allowed me to approach the big day more calmly, since I reached the point of being able to withdraw without too much difficulty the balloon inflated to 8 cm in diameter. I learned and practiced how to relax when ejecting the ball.

On D-day, when the baby’s head passed, I thought very hard about the fact that I had reached 8 cm. Although restrictive, this method paid off for me since I had neither a tear in the perineum nor an episiotomy! But perhaps the perineum massages performed with a specific oil, in parallel, also played a role.

Perineum: build muscle without thinking about it (or almost) with Kegel balls

The Love & Care brand offers a perineum rehabilitation set including 6 Kegel balls of different weights. They are named after Dr. Arnold Kegel, an American gynecologist known in particular for having developed bodybuilding exercises for the perineum and a perineometer. The lightest ball weighs 50 grams, against 130 grams for the heaviest. Made of medical silicone and shaped like a drop of water, they are easy to insert, remove from the vagina and clean.

According to the Passage du Désir website, where you can buy these 6 Love & Care balls, they are ideal for:

• prepare for pregnancy;
• strengthen the perineum after childbirth;
• prevent urinary incontinence;
• increase sensations during intercourse.

How does it work?

As the instructions indicate, the first step is first to find the right weight. Once the balls are washed and dried, settle into a semi-squatting position, as when inserting a tampon. The lightest ball is then inserted into the vagina, with the small cord outside. We contract the perineum, and we thus retain the ball for two minutes. Repeat this with the other weights, until it is difficult to hold the ball. The ball of the lower weight will then be used first as a reference ball.

In a second time, insert the reference ball into the vagina and keep it for 15 minutes, making sure to stay upright (but not necessarily still). When you can walk, run and even cough without feeling uncomfortable, it’s time to move on to the next weight.

The pros:

We are well aware of his pelvic floor, and his weakness, if there is weakness, postpartum. You can follow your progress by gradually opting for a heavier ball than the previous one. You can go about your business with the ball in place, as long as you remain standing.

The – :

At 59 €, the price is still quite high. It is an investment. If we want to go too fast or that we do not trust the instructions for use, there is a risk of overworking and exhausting the perineum, and obtaining the opposite of the expected effect. In addition, the instructions indicate that you must remain standing for 15 minutes: not very suitable for an office activity, for example.

My impressions :

At three months postpartum, I was not seduced by the device, but maybe it was because I had not yet completely completed my perineal rehabilitation and regained good pelvic tone. Rather, the balls left an unpleasant feeling of heaviness, and I was afraid of doing myself more harm than good. That said, you may need to try again later, and sparingly, to see the long-term benefits. At least this object allows you to do something else while building muscles, a very good point for a young mother!

Rehabilitation of the perineum: small tailor-made sessions with the Lelo Smart Bead

“Here is LELO Smart Bead ™, your personal pleasure coach! Thanks to its tactile sensors that respond to all your contractions, LELO Smart Bead ™ measures your orgasmic potential and establishes the routine that suits you. Progress through its 5 levels of vibration, and you will reach longer and more intense orgasms in no time.”. This is word for word what this little purple “sextoy” promises, in the shape of a bean and barely bigger than an egg (approximately 3 x 3 x 8 cm).

The idea is to strengthen your perineum by phases of contraction then relaxation, to the rhythm of the vibrations of the object, vibrations acting on the tone of the interior of the vagina. In return, the device captures the contractions of the perineum, adapts to the perineal tone of the user, and then classifies it according to her level, to make her progress at her own pace. There are five levels, from the beginner who has never done a Kegel exercise, to the expert who masters them, has “excellent” pelvic strength and maximum control. All the operation of the device is detailed in the manual.

The pros:

It’s almost like a physiotherapist, at least when it comes to contraction-relaxation exercises, less feedback. Playful, the object is compact, discreet, easy to take everywhere. It is quite ideal for a woman in postpartum who can not (or not yet) find the time to plan rehabilitation sessions with the physiotherapist or midwife, or who wants to strengthen their effect and ensure a tonic perineum over time.

The – :

The price is again very high, since this little gem of technology costs a whopping 119 euros (you can get it here). And again, you have to stick to an exercise routine to see the results, which requires having a few minutes to yourself here and there.

My impressions :

I was seduced by the design of the object, and by its personalized side. On the other hand, in use, I found the manual a bit complicated, I had to read it several times to be sure to understand and to practice well. The tailor-made aspect is interesting, as is the “additional pleasure mode”, a little moment for yourself after a somewhat tedious exercise session. Safety, comfort and hygiene are indeed there. Despite everything, it is always a question of finding time to rest for a few minutes with your Lelo Smart Bead, in peace, without risking being interrupted in your training. Which is far from obvious when you have just had a baby, or have young children! Perineal rehabilitation sessions with a physiotherapist or midwife are more socially accepted … That said, over time, with a few exercises here and there, this tool can help maintain good perineal tone, lower risk of urinary leakage, and better sexual sensations.

Perineal rehabilitation: why we must not ignore

If nothing prevents a woman in the postpartum period from indulging in a few exercises using various objects designed to strengthen the perineum, it is better not to ignore perineal rehabilitation. The rehabilitation sessions are 100% covered by the health insurance funds and mutuals when prescribed by a gynecologist or midwife. Making an appointment allows you to constrain yourself more than doing a few exercises at homei, not always with great regularity. In addition, this allows a perineal and abdominal assessment to assess the tone of the pelvic floor, and personalized care, adapted to its morphology and physical activities, with practical advice and a whole bunch of important explanations to learn how to properly protect your pelvic floor on a daily basis.

The various objects (geisha balls, Kegel balls, Yoni egg, vibrating egg, etc.) designed to strengthen the perineum can be used as reinforcement. To avoid any risk of misuse, you should seek advice from a specialist beforehand.